Home birth

[Anagray]

Should babies be delivered at home ?

[kids]

I come from a family that home births as a matter of practice. The best I can describe it is think modern "hill folk" with full plumbing & electricity. My cousins families commonly run to 5-10 children. Home birth was not for me, I had complicated deliveries and it is not a safe option for my daughter (due to increased risk of having a baby with a CHD).

I feel that a home birth should be an option if is:

NOT the first baby,

professionally attended,

an uncomplicated pregnancy with consistant pre-natal care

no complications with prior pregnancies or deliveries

and EMS & the hospital are very near.

That said, I do not agree with the way my cousins "do it". Yes, they have great prenatal care and are attended by a licensed mid-wife but they home birth with their first pregnancies. My biggest objection is that they live in an area that from the time you call 911 it takes EMS 15 minutes to arrive and the local EMS (volunteer) only has BLS training. Transport to the nearest hospital is 45 minutes (30 minutes just to get to a freeway). To me that is just to long and far because the "ifs" do happen. The births are a huge family events but I hesitate to attend out of fear for my license, I NEVER go to first births. I am scared that should something go tragicly wrong that the expectation of the BON is that I should have been able to recalled my 12 weeks of L&D rotation from nursing school 13-14 years ago.

On a side note...I empathisize with the chalenges faced by nurses who work in areas with a large Amish (for example) communities. In my area there is a large Apostilolic Lutheren community, they often birth at home with "their own" lay Mid-wives after having professional pre-natal care.

I found it interesting when I was doing Peds HH how much of my visit case load was their babies for things like NG tube placement & teaching for FTT and follow-ups for SGA, IUGR and post Nissan for GERD (I have done teaching & followup on as many as 4 children at 1 visit, cousins-their Mom's gathered a one home to save me from having to go house to house).

My understanding is that this Order orignated in Norway/Sweden/Denmark (I can't remember what that geographic area is "called"). I do know that they have very strong rules about consanguinity, there is much marrying between families and rarely they marry outside of their religion. I've wondered if there is a connection. (sorry, talking to myself)

[mark_LD_RN]

of course good prenatal care is a must. but do not see a problem or a difference being first pregnancy or not. not really much difference I have seen first ones go fine and problems develope with subsequent deliveries.

the biggest issue is good prenatal care adequate pelvis, trained provider and being near to the hospital,30-45 minutes is just to far away for me:)

[NICU_Nurse, BSN, RN]

I fully support the idea of home-like birthing centers that adjoin the hospital. I used to be a huge advocate of the choice to homebirth, and after working in NICU I've become much less vocal about it. I still support the choice, given healthy 'circumstances', to birth at home if you want, but I feel much more comfortable knowing that an NICU with trained professionals is a mere elevator ride away should complications arise.

[canoehead, BSN, RN]

Perhaps we are going at this the wrong way. Maybe hospitals should be supported in leaving decisions to the parents so they will be willing to come in and have the babies in a safer environment.

[OBNURSEHEATHER]

Originally posted by canoehead

Maybe hospitals should be supported in leaving decisions to the parents so they will be willing to come in and have the babies in a safer environment.

Excellent idea! But how the hell do we do that?

I work at a large hospital, about 5,500 deliveries a year. The assembly line philosophy is just too difficult to break.

[canoehead, BSN, RN]

I have no solutions...the attitude has to change, and that will take decades even if we start tomorrow. Maybe smaller units, or starting with empowering the families in one unit for very low risk people and expanding out?

But I will be cold and dead before I support the bleacher seat concept of birthing- you know what I mean.

[semstr]

Well since I am from the country with the most homebirths in the western world, of course I voted yes.

BUT,

There are a lot of things to be followed, one of them the exact prenatal care and monitoring of mother and child.

Next clinic must be in reachable distance.

Direct phone to a standby pediatrician, or a "baby-lance"

An expirienced midwife and nurse.

Enough room around the birthingplace.

When bigger kids are there, who is going to take care of them?

And who is going to take care of mother and child after the birth?

In the Netherlands insurances pay for a special trained pp-nursing aide, who comes to your home for a week and takes care of, not only mother and child, but also cooks and does "light" cleaning work and looks after people coming to visit.

Midwife comes once a day for a week too, to check the mother.

But in the Netherlands more and more women are going to the hospital or birth-centre to deliver. They deliver and 2 hours later they go home.

In Austria almost all the women deliver in hospitals or birth-centres and they can stay a few days.

[mark_LD_RN]

I agree canoehead, the attitude needs to change so people will feel comfortable coming to the hospital! where i work at we try i know i do my best:) it helps that we are kind of small. I work at some larger hospitals and did not care for the assembly line mentallity.

on the other hand i do not feel the need for couples to deliver in a hospital with a NICU, if it is an uncomplicated term pregnancy:)

[kimmicoobug]

I like the idea of homebirth, but I do think it can be risky. An example is my cousin who has had two homebirths. With the first one, she had complications with the labor and had to be rushed to the hospital after the delivery because of hemorrhage. With the second homebirth, baby was born with the intestines on the outside (can not remember name of this condition).

I think this practice can be safe, and I voted as such, but think the patient should really research whatever homebirth center she decides to go with. I heard after my cousin's delivery, that this particular center only saw dollar signs when taking patients and that my cousin should have never have been a candidate after her first homebirth. However, I did hear this from a few OB nurses, so there may be some bias:)

[keeper]

I have to disagree with the sentiment that previous complications should preclude a woman from having a homebirth in subsequent pregnancies. Unless the complication is a recto-lady partsl fistula I can't see where most complications will affect another pregnancy.

(I know there may be other examples, but this is the one I can think of now.)

If a patient had suffered PPH, it will be important for a midwife to know that, so she can be ready in the event of a repeat. I don't think it means the mom is doomed to repeat it, though, especially with the midwifery emphasis on nutrition.

[mark_LD_RN]

i also do not believe all problems with a previous pregnancy would prevent one from having a home birth with the next ones. as lond as she has an adequate pelvis and non macrosomic baby

[kimmicoobug]

Ok, thanks for input, guys, since I assume that was directed towards my post. Like I said, I had heard that from some OB nurses when I discussed about my cousin's delivery with them, and that is what I was told. (gosh, I hope that is not read with sarcasm, because it isn't meant that way:) ). To be honest, I don't know a whole lot about this subject (as may be evident by my post), and will eventually research it further when time permits. I do have a whole lot of respect for women who choose to do it this way, and despite my cousin's problems with her labors, I gotta give that girl some credit. (she actually had three, but had to be rushed to the hospital for predelivery problems...delivered only two at home. The two I had posted previously of were her first and third).

All of the other cases of home birth with the care of a certified individual has actually all been very positive that I have heard of.